Физиологические корреляты вариабельности сердечного ритма (обзор)

Исследуется (кроме самой кардиограммы) вариабельность сердечного ритма (ВСР), как одна из информативных, но сложных в практической медицине.

Physiological Correlators Variabilities of the Intimate Phythm.

Researches of last decades have shown, that the quantity of cardiovascular diseases at the population progressively increases. Therefore the actual meaning for health of people is got with ways of a tentative estimation of health of the population. Within the limits of the given problem the quantitative parallel estimation of parameters VSR which can give a simple opportunity concerning fast is rather actual and accessible to the general clinical laboratory to estimate a condition of cardiovascular system. In the given review variability of an intimate rhythm (VSR), as one of informative, but complex in applied medicine is considered. The numerical values received as a result of analysis VSR are estimated various the researcher differently, depending on the used scientific-theoretical concept. Not stopping in details on methods of analysis VSR, in the review a number of the most used parameters which will be used at the further statement of data is considered. Methods of the time and frequency analysis are shown. To the first, statistical methods concern to the second - spectral. On VSR can influence a number minium take into consederation at interpritation factors. Regulation of a rhythm of heart is in norm under dominating influence parosimpatics nervous system. In absence of any vegetative influences (for example, at creation of full medicamentous vago-sympathetic blockade) level Chss (a so-called "true" rhythm of heart) the healthy adult person makes 100 6fi/ mines and above. Thus, registered increase Chss at patients in various nozological age groups can be both display of strengthening of sympathetic activity, and an attribute of development of total vegetative blockade of heart. Calculations FST, SDNN are most simple procedure of statistical analysis VSR. Growth or reduction FST can be connected both with an independent contour of regulation, and with central. Significant influence on formation of picture VSR render not only a tone of vegetative nervous system, but also a condition of the myocardium, spending system of heart that is especially essentially shown at patients with cardiagical a pathology. It is noted, that changes VSR accompany with various cardiological and not cardiological diseases. Essentially limits application of analysis VSR in the cardiological clinic, traditional directivity it only on an estimation sine a rhythm. The given approach completely excludes an opportunity of an estimation of an intimate rhythm at patients with the core geterotropical the driver of a rhythm. However, as a rule, it is patients with chronic forms of heavy infringements of a rhythm of heart which treatment demands the account of a maximum quantity of the factors, capable to estimate weight of current of disease, a degree of efficiency of therapy and the forecast. Decrease VSR can reflect downturn vagus activity concerning the heart, leading domination of sympathetic mechanisms and electric instability of heart. In a sharp phase decrease daily SDNN is authentically connected by IT with development of dysfunction left ventricle, peak value Kreatinfosfocinasa and a class on Killipu. It is informed also on revealing the lowered absolute capacity of LF and ВЧ components in controllable conditions at diabetic patients without attributes vegetative neyropaty. According to the stated approach two basic functions VSR are allocated: disorder and concentration. Function of disorder parameters SDNN, SDNN-I and delta H, TINN, TIRR test, variations of short sites ritmogramma. In short samples sine a rhythm, in conditions temporal homogeneity process function of disorder tests parasimpatic a department of regulation, however at patients with the core non sine a rhythm (full blockade, vibrating arrhythmia, a syndrome of weakness sine unit) have no obvious vegetative dependence, and define a possible adaptive corridor of fluctuations of a rhythm. The integrated method of interpretation VSR based on allocation of concrete functions of the driver of a rhythm (disorder and concentration), irrespective of a source of a rhythm and temporal homogeneity process at patients with defeat of a myocardium and spending system of heart, can be applied at an estimation of results holter monitorings, as additional in comparison with other methods of analysis VSR. The importance of the standard analysis of time and frequency characteristics has been comprehensively studied in several independent prospective researches, however owing to use of the optimized boundary sizes defining normal and lowered VSR, these researches can overestimate a little predicted value VSR. Modern methods of the analysis of the time parameters, mainly used in an expert, are, possibly, sufficient for an estimation of long-term structure VSR. Improvements can concern accuracy of numerical sizes. Modern nonparametric and parametrical spectral methods also use for the analysis of short-term electrocardiograms without passing changes of modulations of an intimate cycle. Besides need for development of highly reliable numerical techniques for completely automatic measurement, geometrical methods represent only one of such variants. Variability of an intimate rhythm possesses significant potential for definition of a role of fluctuations of vegetative nervous system at healthy and at patients with various cardiovascular and other diseases. Researches VSR should improve our understanding of physiological phenomena, actions of preparations and mechanisms of development of illnesses. Large prospective researches on greater contingents are called to define sensitivity, specificity and predicted importance VSR for definition of the patients having raised risk of death or other pathological condition.